Healthcare Provider Details

I. General information

NPI: 1598244899
Provider Name (Legal Business Name): CORY LEE ORTIZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 BEACHVIEW ST STE 110
DALLAS TX
75218-3704
US

IV. Provider business mailing address

1130 BEACHVIEW ST STE 110
DALLAS TX
75218-3704
US

V. Phone/Fax

Practice location:
  • Phone: 214-538-2559
  • Fax: 844-364-8679
Mailing address:
  • Phone: 817-461-4257
  • Fax: 817-461-4257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1308590
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: